ch.35 bone disorders

Question 0

Identify these diseases:

• loss of bone mass and skeletal fragility; causes morbidity; most pronounced in postmenopausal women.
• bone remodeling , misshapen or enlarged bones; limited to 1 or few bones; bone pain ,deformities, fractures
• softening of bones; attributed to vitamin D defieciency

Answer 0

• Osteoporosis
• Paget’s disease
• Osteomalcia

Question 1

Osteomalcia in children is referred to as ?

Answer 1

Rickets

Question 2

function osteoCLASTS and osteoBLASTS?

Answer 2

CLASTS: break down bone
BLASTS: “bone-building cells”

Question 3

purpose of bone mineralization? attributed to ?

how does bone loss occur?

Answer 3

mineralization essential for bone strenght; attributed from hydroxyapatite (calcium phosphate)–>deposit in bone matrix

bone loss : bone resporption (process: bone breakdown- osteoclasts) exceeds bone formation during remodeling process

Question 4

bone resportion

Answer 4

bone break down process (osteoclasts)

Question 5

glucocorticoids increase loss or gain?

-prednisone 5mg/day 3 months risk factor?

Answer 5

bone loss

-risk for osteoporosis

Question 6

reducing bone loss in postmenopausal women?

Answer 6

intake of calcium and vit D, weight bearing exercises , smoking cessation

Question 7

alendronate, ibandronate, risedronate, zoledronic acid along with etidronate, pamidronate, tiludronate are ?

Answer 7

bisphosphoNATES

• postmenopausal osteoporosis
• Paget’s disease
• bone metastases and hypercalcemia of malignancy

Question 8

MOA of bisphosphonates:

-first line drugs for treatment of osteoporosis

Answer 8

decrease osteoclastic bone resorption; increase of osteoclastic apoptosis and inhibition of cholesterol biosynthetic pathway important for osteoclast function

Question 9

beneficial effects of which drugs persist over several years of therapy , but discontinuation results in a gradual loss of effects?

Answer 9

aledronate

Question 10

• avidly bind to hydroxyapatite in bone

- should be avoided in severe renal impairment

Answer 10

bisphosphonates

-alendronate, risedronate, ibandronate

Question 11

when oral bisphosphanates are not tolerated we use which IV bisphosphanates?

Answer 11

ibandronate

zoledronic acid

Question 12

associated with esphagitits and esophageal ulcers.

-pt should remain upright for 60min after taking oral bisphonates

Answer 12

alendronate,risdronate,ibandronate

Question 13

osteonecrosis is associated with

Answer 13

intravenous doses used for hypercalcemia of malignancy.

-bisphosphonates

Question 14

bisphosphonate that causes ostemalacia after long term use ?

Answer 14

Etidronate

Question 15

after menopause what promotes proliferation and activation of osteoclasts?

Answer 15

low estrogen levels

Question 16

effective for the prevention ofmpostmenopausal bone loss

Answer 16

estrogen

Question 17

increases the risk of endometrial cancer, breast cancer, stroke, VENOUS THROMBOLISM , coronary events

Answer 17

estrogen

Question 18

selective estrogen receptor modulator approved for the treatment of osteoporosis
-reduces levels of total and low density lipoprotein cholesterol

Answer 18

raloxifene

Question 19

hot flashes, leg cramps, risk of venous thrombolism are adverse effects of

Answer 19

raloxifene

Question 20

2nd line treatment osteoporosis in postmenopausal women who are at least 5 years postmenopausal

Answer 20

calcitonin

Question 21

it reduces bone resporption, but less effective than bisphosphonates

• relief of pain associated with osteoporotic fractures, recent vertebral fractures
• intranasal or parental formulation (rarely used in osteoporosis treatmente IV)

Answer 21

calcitonin

Question 22

rhinitis and other nasal symptoms are adverse effects of

Answer 22

calcitinonin

Question 23

resistance to calcitonin , obeserved in long term use for which disease?

Answer 23

Paget’s disease

Question 24

monoclonal antibody that targets receptor activator of nuclear factor Kappa- B ligand and inhibits osteoclast formation and function

• post menopausal osteoporosis for women at high risk of fracture
• subcutaneous injections every 6 months

Answer 24

denosumab

Question 25

postmenopausal osteoporosis drug associated with adverse effects of infection, hypocalcemia, osteonecrosis of the jaw, atypical fractures

Answer 25

denosumab

Question 26

a recombinant form of human parathyroid hormone

• subcutanous daily
• treats osteoporosis

Answer 26

teriparatide

Question 27

First approved treatment for osteoporosis that stimulates bone formation (osteoblastic activity).
-associated for patients with high risk fracture

Answer 27

teriparatide